Case Histories and Discourse analysis

Posted: November 17, 2008 in Methods, Readings, Review, School

The reading for this week was chapters from Carol Berkenkotter’s upcoming Patient Tales and a chapter on researching through discourse and textual analysis. I’ll start there.

Discourse and Textual Analysis are where I feel most comfortable. They don’t involve human subjects, they proceed at the pace of the researcher, and they involve close attention to detail. Add to that some rather extensive background in this sort of thing (it is pretty much exclusively how my Philosophy training was focused), and you have a pretty understandable love of this kind of research. This is the stuff that feels like research. The books spread out across the huge desk, the notes, the piles and piles of papers. Sifting through mountains of text, looking for that one perfect quotation. There’s an honesty to it, I think. A visceral joy that may not come with other kinds of research.

I’m not saying other research is inferior, nor do I want to imply that it isn’t “real”; there’s a lot that other types of research can do that discourse analysis can’t. DA is, in many, many ways, very limited. It’s a first step, usually. A jumping off point for research to begin from. Other things, like Case Studies, offer a whole lot more. What I’m saying is that different research methods work better than others for specific projects. You have to pick what method to use for each project. That feels about as obvious as saying that the sky is blue, but I know for students (myself included) this is a lesson that has to be learned. Well, not exactly learned as pointed out.

Now let me talk about Berkenkotter…

I found this work to be fascinating. In part, it was a tangential interest: a very good friend of mine is a behavioral psychologist, working on his dissertation. The types of case study examined in this book are the kinds of things he does for a living. But above and beyond my personal interest, what I read of this book (the introduction, chapter 6, and chapter 7) was interesting in its own right.

The introduction starts by pointing out the danger of narrative structure, but also its pervasiveness and its usefulness. It touched on the mind-body problem, an issue always dear to my heart, and Berkenkotter pointed out very nicely that “although mental life is comprised of neural events, it is considerably more than the sum of those events” (5). I’m not sure I agree, but it’s very well said.

What follows is a brief history of the case history in psychology, followed by, like so many other sources, a Methods section. It isn’t labeled as a methods section (instead as “Using a Multimodal Research Approach to a Complex Historical Subject Matter” (9)), but it outlines the methods just the same, going through how specific case studies will be examined and how “A close reading and analysis of written texts was essential, but it was also important that I integrate close reading (interpretive analysis) with a more systematic approach…” (9). In other words, how she will both engage in case study research and in discourse analysis (this entry is turning out to be much more nicely circular than normal).

In chapter 6, we are deep in the meat of the book. We are now discussing the five genres of case history (which is not case study, but is similar): “(1) the single-case history, with n of 1… (2) truncated case histories that were peer reviewed but appeared in the letters to the editor section… (3) “hybrids,’ or embedded case studies appearing in articles… (4) multiple-subject case reports… and (5) case histories forming the subject of clinical case conferences…” (143). But we are also discussing how close the genre of case histories came to extinction. How a change “in orientation in psychiatry toward the methods of epistemology of the natural sciences…” (132) made it more difficult to present a narrative structure (which seems vital for case reports). The main idea of this chapter, as I could see, was that case reports are not unscientific. They are very useful, and deserve to continue on as a legitimate field.

Next, in chapter 7, we get in to the Psychotherapist as Author, which is the title of the chapter. Here we learn the real purpose of a case history: to help future therapists help a patient. As Berkenkotter writes, “These narratives are typically read by the therapist, his or her supervisor, a psychiatrist or physician (if a referral is made for medication), and possibly a judge, a new therapist, or an insurance company auditor” (152). One thing that interested me about this was that the client wasn’t mentioned in the list. This is addressed in the very next sentence “Although clients legally have a right to review their records, they rarely request and therapists do not generally promote this option. Therefore, the client is seldom seen as a potential audience” (152).

Kind of makes me want to hunt down every therapist I’ve ever spoken to and read the case report. But then I run into the problem of why clients don’t usually ask: I’m not sure I’d want to know. If someone had classified me as a schizophrenic, or a sociopath, I think I’d be happier just not knowing. And this is one of those cases where the only news is bad news. If it was what I expected (which for the record is not to be labeled either of those two things), then I would have gained nothing.

But anyway, back to Berkenkotter. The end of the chapter brings up something both interesting and disheartening: “Somewhere along the way the client’s richly descriptive narrative is lost, the result of the therapist’s use of rhetorical and linguistic strategies that lend credence to her diagnosis, the primary practice for which she is billable” (159). While this makes sense –more important to do their job than to keep the client’s story– it still strikes me as unfortunate.

As has happened so much this semester, I’m interested in the structure rather than the content. I think it’s a great book, and plan to recommend it to my friend, though the content does not go quite with my own focus.


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